Cargando…
A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction
INTRODUCTION: Traumatic diaphragmatic hernia is a rare and often under recognized complication of penetrating and blunt trauma. These injuries are often missed or there is a delay in diagnosis which can lead to enlargement of the defect and the development of abdominal or respiratory symptoms. PRESE...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336435/ https://www.ncbi.nlm.nih.gov/pubmed/25623756 http://dx.doi.org/10.1016/j.ijscr.2015.01.023 |
_version_ | 1782358467783163904 |
---|---|
author | Pakula, Andrea Jones, Amber Syed, Javed Skinner, Ruby |
author_facet | Pakula, Andrea Jones, Amber Syed, Javed Skinner, Ruby |
author_sort | Pakula, Andrea |
collection | PubMed |
description | INTRODUCTION: Traumatic diaphragmatic hernia is a rare and often under recognized complication of penetrating and blunt trauma. These injuries are often missed or there is a delay in diagnosis which can lead to enlargement of the defect and the development of abdominal or respiratory symptoms. PRESENTATION OF CASE: We report a case of an otherwise healthy 37 year old male who was involved in a motor vehicle accident at age twelve. He presented 25 years later with vague lower abdominal symptoms and was found to have a large chronic left sided diaphragmatic hernia involving the majority of his intra-abdominal contents. Repair of the defect with a biologic mesh was undertaken and the patient also required complex abdominal wall reconstruction due to loss of intra-abdominal domain from the chronicity of the hernia. A staged closure of the abdomen was performed first with placement of a Wittmann patch. Medical management of intra-abdominal hypertension was successful and the midline fascia was sequentially approximated at the bedside for three days. The final closure was performed with a component separation and implantation of a fenestrated biologic fetal bovine mesh to reinforce the closure. In addition, a lightweight Ultrapro mesh was placed for additional lateral reinforcement. The patient recovered well and was discharged home. DISCUSSION: These injuries are rare and diagnosis is challenging. Mechanism and CT scan characteristics can aid clinicians. CONCLUSION: Blunt diaphragmatic injury is rare and remains a diagnostic challenge. Depending on the chronicity of the injury, repair may require complex surgical decision making. |
format | Online Article Text |
id | pubmed-4336435 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-43364352015-03-03 A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction Pakula, Andrea Jones, Amber Syed, Javed Skinner, Ruby Int J Surg Case Rep Case Report INTRODUCTION: Traumatic diaphragmatic hernia is a rare and often under recognized complication of penetrating and blunt trauma. These injuries are often missed or there is a delay in diagnosis which can lead to enlargement of the defect and the development of abdominal or respiratory symptoms. PRESENTATION OF CASE: We report a case of an otherwise healthy 37 year old male who was involved in a motor vehicle accident at age twelve. He presented 25 years later with vague lower abdominal symptoms and was found to have a large chronic left sided diaphragmatic hernia involving the majority of his intra-abdominal contents. Repair of the defect with a biologic mesh was undertaken and the patient also required complex abdominal wall reconstruction due to loss of intra-abdominal domain from the chronicity of the hernia. A staged closure of the abdomen was performed first with placement of a Wittmann patch. Medical management of intra-abdominal hypertension was successful and the midline fascia was sequentially approximated at the bedside for three days. The final closure was performed with a component separation and implantation of a fenestrated biologic fetal bovine mesh to reinforce the closure. In addition, a lightweight Ultrapro mesh was placed for additional lateral reinforcement. The patient recovered well and was discharged home. DISCUSSION: These injuries are rare and diagnosis is challenging. Mechanism and CT scan characteristics can aid clinicians. CONCLUSION: Blunt diaphragmatic injury is rare and remains a diagnostic challenge. Depending on the chronicity of the injury, repair may require complex surgical decision making. Elsevier 2015-01-15 /pmc/articles/PMC4336435/ /pubmed/25623756 http://dx.doi.org/10.1016/j.ijscr.2015.01.023 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). |
spellingShingle | Case Report Pakula, Andrea Jones, Amber Syed, Javed Skinner, Ruby A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction |
title | A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction |
title_full | A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction |
title_fullStr | A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction |
title_full_unstemmed | A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction |
title_short | A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction |
title_sort | rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336435/ https://www.ncbi.nlm.nih.gov/pubmed/25623756 http://dx.doi.org/10.1016/j.ijscr.2015.01.023 |
work_keys_str_mv | AT pakulaandrea ararecaseofchronictraumaticdiaphragmaticherniarequiringcomplexabdominalwallreconstruction AT jonesamber ararecaseofchronictraumaticdiaphragmaticherniarequiringcomplexabdominalwallreconstruction AT syedjaved ararecaseofchronictraumaticdiaphragmaticherniarequiringcomplexabdominalwallreconstruction AT skinnerruby ararecaseofchronictraumaticdiaphragmaticherniarequiringcomplexabdominalwallreconstruction AT pakulaandrea rarecaseofchronictraumaticdiaphragmaticherniarequiringcomplexabdominalwallreconstruction AT jonesamber rarecaseofchronictraumaticdiaphragmaticherniarequiringcomplexabdominalwallreconstruction AT syedjaved rarecaseofchronictraumaticdiaphragmaticherniarequiringcomplexabdominalwallreconstruction AT skinnerruby rarecaseofchronictraumaticdiaphragmaticherniarequiringcomplexabdominalwallreconstruction |